Foot & Ankle

The focus of the Foot and Ankle team’s research is looking at the surgical options for patients with end-stage ankle arthritis – specifically, ankle fusion or total ankle replacement. It is not yet clear which of these options is best for the patient.

Led by Dr. Timothy Daniels, head of Orthopedic Surgery and the first appointed foot and ankle chair, the team has established, in collaboration with Dr. Geoff Fernie of the Toronto Rehabilitation Institute, a Challenging Environment Assessment Lab – a one-of-a-kind, state-of-the-art laboratory to study the impact and effects of ankle arthritis on gait in various environmental settings and climate.

Presently, the team has one of the largest prospective registries on patients surgically managed for ankle arthritis. The registry includes preoperative and annual postoperative validated outcome questionnaires.  The registry will answer many of the uncertainties and questions regarding ankle arthritis over the next decade.

With ankle replacement and ankle fusion procedures occurring on a regular basis at St. Michael’s Hospital, the registry continues to be updated constantly. This allows the team to gauge the effectiveness and lifespan of an ankle replacement, resulting in great advancements towards the treatment of ankle arthritis.


Core Researchers

Featured Studies

Patient Outcome Registry for the Evaluation of Ankle Arthritis

The Foot and Ankle team has one of the largest prospective registries on patients surgically managed for ankle arthritis which includes preoperative and annual postoperative validated outcome questionnaires. The registry will answer many of the uncertainties and questions regarding ankle arthritis over the next decade.

With ankle replacement surgeries – along with ankle fusions – occurring on a regular basis at St. Michael’s Hospital, the registry continues to be updated constantly. This allows the team to gauge the effectiveness and lifespan of an ankle replacement, resulting in great advancements towards the treatment of ankle arthritis.


Functional and radiological outcome analysis of the Scandinavian total ankle replacement and Hintegra total ankle prostheses

With the rise of total ankle arthroplasty, the designs of ankle arthroplasty models and surgical methods have been constantly changing. This study is exploring the efficacy of the Scandinavian total ankle replacement and Hintegra prostheses through a retrospective comparative analysis using 100 patients.


Bilateral ankle arthritis patients with bilateral ankle replacements

To date, there has been a paucity of studies exploring the demographics, functional capacity, and health status of patients with ankle arthrosis (Buckwalter, 2004; Thomas, 2003; Agel, 2005). There is a complete void in the literature exploring these characteristics in patients with bilateral ankle arthrosis. The purpose of the study was to compare patients with end-stage unilateral ankle arthrosis awaiting surgical intervention to patients with bilateral ankle arthrosis in terms of loss of function, pain and health-related quality of life. In addition, the research team also examined the mid-term outcome of patients with bilateral arthritis who have undergone bilateral total ankle replacements to a cohort of patients with unilateral arthritis who have undergone unilateral total ankle replacement.


A Hintegra implant’s components

Postoperative analgesia with continuous peripheral nerve block after foot and ankle or shoulder surgery in ambulatory patients – A Phase 1 feasibility study, this research project is based on previous evidence that suggests continuous peripheral nerve block provided at home improves postoperative analgesia, sleep quality and patient satisfaction while decreasing supplemental opioid requirements and opioid-related side effects. It hypothesizes that a continuous peripheral nerve block as such will provide superior analgesia for foot and ankle and shoulder surgery in comparison to a single shot block and intravenous analgesics. Patients normally need to stay in the hospital overnight for such treatment, but the use of continuous peripheral nerve block can refute that requirement. Ten adult patients who underwent foot and ankle surgery and 10 adult patients who underwent shoulder surgery have been investigated, as per protocol.


“Ankle-at-risk” signs: radiographic predictors of poor outcomes of joint-sparing techniques in adult-acquired flatfoot deformity

This research aims to pose a set of radiographic “ankle-at-risk” signs to help predict which patients with adult-acquired flatfoot deformity will have poor outcomes with joint-sparing techniques and would thus need to be considered with joint-sacrificing techniques as a primary option. This project has led to the identification of 10 “ankle-at-risk” signs which can help predict which adult-acquired flatfoot deformity patients will have improved outcomes with joint-sacrificing rather than sparing treatment techniques – this was done through a retrospective review of preoperative X-rays belonging to a case series of patients who underwent flat foot reconstruction between 2004 and 2012. The findings were compared to postoperative correction rate and revision rate to identify any correlations.


A randomized, controlled clinical trial to evaluate the effect on patients of weight-bearing status after arthroscopic forage of osteochondral defects of the ankle

This project is a prospective, randomized, controlled, non-inferiority clinical trial that is being conducted to evaluate the effect of weight-bearing as tolerated in comparison to non-weight bearing on patient outcomes following arthroscopic forage of osteochondral defects of the ankle. The main hypothesis posed was there will be no difference in subjective patient outcome scores between the immediate and delayed weight-bearing groups. A secondary hypothesis, judged via observation of healing on CT scans as a secondary measure, postulates that there will be no difference in objective radiologic findings of osteochondral healing between these two groups one year after surgery. This supports the desired concept of early mobilization and the return to function for patients who have undergone such procedures. This is significant with regards to the minimization of morbidity and costs associated with non-weight bearing cases, such as mobility aids, transportation and loss of income as a result of inability to function, and so on.

Our Sponsors

  • Integra Life Sciences
  • Cartiva Inc.
  • Wright Medical

Featured Publications

  • Daniels TR, Mayich DJ, Brodsky JW, Novak A, Perry SD. Gait analysis for foot and ankle surgeons — topical review, part 2: Approaches to multisegmental modeling of the foot. Foot and Ankle International. 2014 Feb;35(2):178-91. Foot Ankle Int. 2014 Feb;35(2):178-91. Co-Principal Author.
  • Daniels TR, Dryden PJ, Glazebrook M, Penner MJ, Wing KJ, Wong H, Yonger AE. Intermediate-term results of total ankle replacement and ankle arthrodesis: a COFAS multicenter study. JBJS-Am. JBJS Am. 2014 Jan 15;96(2):135-142. Principal Author.
  • Daniels TR, Mayich DJ, Brodsky JW, Novak A, Vena D. Gait analysis in orthopaedic foot and ankle surgery– topical review, part 1: Principles and uses of gait analysis. Foot and Ankle International. 2014 Jan;35(1):80-90. Foot Ankle Int. 2014 Jan;35(1):80-90. Co-Principal Author.
    Daniels TR, Klejman S, Pinsker E, Singer, S, Houck J. Ankle arthroplasty and ankle arthrodesis: Gait analysis compared with normal controls. Journal of Bone and Joint Surgery (American). 2013:95:3191(1-10) (Trainee publication, Dr. Syndie Singer). Principal Author.
  • Daniels TR, Baumhauer J, Beasley W, DiGiovanni CW, Donahue R, Lin SS, Pinzur MS. Survey on the need for bone graft in foot and ankle fusion surgery. Foot and Ankle International. 2013 Dec;34(12):1629-33. Foot Ankle Int. 2013 Dec;34(12):1629-33. Co-Principal Author.
  • Daniels TR, Baumhauer J, Beasley W, DiGiovanni CW, Donahue R, Evangelista PT, Glazebrook M, Pinzur MS, Younger AE. Establishing the relationship between clinical outcome and extent of osseous bridging between computed tomography assessment in isolated hindfoot and ankle fusions. Foot and Ankle International. 2013 Dec;34(12):1612-8. Foot Ankle Int. 2013 Dec;34(12):1612-8. Co-Principal Author.
  • Daniels TR. Surgical Technique for total ankle arthroplasty in ankles with preoperative coronal plane varus deformity 10 degrees or greater. Journal of Bone & Joint Surgery – American Volume. 2013 Nov 27. JBJS Essential Surgical Techniques, 2013 Nov 27;3(4)e22 1-10. Principal Author.
  • Daniels TR. Video: Surgical Technique for total ankle arthroplasty in ankles with preoperative coronal plane varus deformity 10 degrees or greater. Journal of Bone & Joint Surgery – American Volume. 2013 Oct 2. Principal Author.
  • Daniels TR, Baumhauer J, DiGiovanni CW, Donahue R, Evangelista P, Glazebrook M, Pinzur, M, Younger A. Establishing the relationship between clinical outcome and extent of osseous bridging between CT assessment in isolated hindfoot and ankle fusions. Foot and Ankle International. 2013 Sep 16. Co-Principal Author.
  • Daniels TR, the PRAISE Investigators. Prevalence of Abuse and Intimate partner violence Surgical Evaluation (PRAISE): A multi-national prevalence study in orthopaedic fracture clinics. Lancet. Lancet. 2013 Sep 7;382(9895):866-76. Coauthor or Collaborator.
  • Daniels TR, Baumhauer J, Beasley W, DiGiovanni CW, Donahue R, Lin SS, Pinzur, M, Younger A. Survey on the need for bone graft in foot and ankle fusion surgery. Foot and Ankle International. 2013 Aug 28. Co-Principal Author.
  • Daniels TR, Trajkovski T, Cadden A, Pinsker E. Outcomes of ankle arthroplasty with preoperative coronal-plane varus deformity 10 degrees or greater. Journal of Bone & Joint Surgery – American Volume. 2013 Aug 7;95(15):1382-88. Principal Author.
  • Daniels TR, Mayich DJ, Mayich MS, Pinsker E, Mak W. An anlysis of the use of the Kellgren and Lawrence grading system to evaluate peritalar arthritis following total ankle arthroplasty. Foot and Ankle International. Foot Ankle Int. 2013 Nov;34(11):1508-15. Co-Principal Author.
  • Sprague S, Goslings JC, Petrisor B, Avram V, Ayeni OR, Schemitsch E, Poolman RW, Madden K, Godin K, Dosanjh S, Bhandari M, P.O.S.I.T.I.V.E Investigators (Daniels T). Patient opinions of screening for intimate partner violence in a fracture clinic setting: P.O.S.I.T.I.V.E.: a multicenter study. Journal of Bone and Joint Surgery (Am). 2013 Jul 3;95(13). 391. doi: 10.2106/JBJS.L.01326. Coauthor or Collaborator.
  • Daniels TR, DiGiovanni CW, Lin SS, Baumhauer JF, Younger A, Glazebrook M, Andreson J, Anderson R, Evangelista P, Lynch SE, the North American Orthopedic Foot and Ankle Study Group. Recombinant Human Platelet-Derived Growth Factor-BB and Beta-Tricalcium Phosphate (rhPDGF-BB/B-TCP): An Alternative to Autogenous Bone Graft. Journal of Bone and Joint Surgery (Am). 2013 Jul 3;95(13):1184-92. Co-Principal Author.
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